苦黄注射液对黄疸型病毒性肝炎退黄降酶效果及安全性的系统评价

目的:系统评价苦黄注射液对黄疸型病毒性肝炎退黄降酶的有效性和安全性。方法:计算机检索Cochrane图书馆、PubMed、中国生物医学文献数据库(CBM)、维普中文科技期刊数据库(VIP)、中国期刊全文数据库(CNKI)、中文生物医学期刊文献数据库(CMCC)及万方数据库,对纳入的随机及半随机对照试验进行质量评价,并用RevMan5.0软件进行Meta分析。结果:共纳入7项研究,合计患者726例。对于急性黄疸型肝炎,苦黄注射液降低总胆红素(TBIL)和丙氨酸氨基转移酶(ALT)疗效与腺苷蛋氨酸相当[WMD=16.69,95%CI(-4.11,37.48)]和[WMD=14.87,95%CI(-90.49,120.22)];对慢性肝炎,其降TBIL和ALT疗效均不及腺苷蛋氨酸[WMD=41.87,95%C(I31.12,52.63)]和[WMD=79.64,95%CI(50.06,109.22)];亚组分析显示,剂量大于30mL组降ALT效果与腺苷蛋氨酸相当[WMD=58.49,95%C(I-34.45,151.43)]。现有资料未提示严重不良反应。结论:苦黄注射液治疗黄疸型病毒性肝炎有一定的退黄降酶效果,增加剂量可能提高降酶疗效。其疗效和安全性尚待更多高质量研究予以进一步证实。     

左旋卡尼汀改善慢性心力衰竭患者心功能的系统评价

目的 系统评价左旋卡尼汀改善慢性心力衰竭患者心功能的临床疗效和安全性.方法 检索万方数据库和中国期刊全文数据库.纳入含左旋卡尼汀改善慢性心力衰竭患者心功能的随机对照研究.结果 共纳入25个随机对照研究,1938例患者,Meta分析结果表明,加用左旋卡尼汀治疗组的治疗效果优于对照组[OR=1.30,95%CI(1.21,1.39)].结论 左旋卡尼汀应用于改善慢性心力衰竭患者的治疗是有效的.由于本系统评价纳入的研究存在偏倚的可能,对结果的论证强度会有影响,期待有更多高质量的随机对照试验加以证明.     

百令胶囊治疗慢性肾衰有效性系统评价

目的:评价百令胶囊治疗慢性肾衰的有效性。方法:检索的中文数据库包括中国知网、中国期刊全文数据库、中国学位论文全文数据库和万方数据库;维普数据库;检索的外文数据库为Cochrane图书馆、Medline(EBSCO)和Pub Med。按Cochrane系统评价的方法评价纳入研究质量,对同质研究采用Rev Man5.2进行Meta分析。结果:检索到符合要求的文献共78篇,纳入系统评价文献17篇,患者1 570名。利用JADAD评分量表和Cochrane偏倚风险评估量表对纳入的研究进行质量评分。根据纳入RCT百令胶囊及其联合用药的情况,进行亚组分析,Meta分析结果显示,百令胶囊治疗慢性肾衰竭有效率(RR=1.22,95%CI:1.10~1.35,P<0.01),改善尿素氮(RR=-3.18,95%CI:-4.38~-1.91,P<0.01)发表偏倚方面,纳入的RCT研究均为低偏倚风险,结论:基于当前证据,使用百令胶囊治疗慢性肾衰确有疗效;但文献质量有待提高。     

腺苷蛋氨酸联合门冬氨酸钾镁与苦黄注射液治疗慢性乙型肝炎肝内淤积综合征效果比较

我院在基础护肝治疗基础上加用腺苷蛋氨酸联合门冬氨酸钾镁治疗慢性乙型肝炎肝内胆汁淤积综合征,并与基础护肝加苦黄注射液治疗作比较,取得满意效果。现报道如下：     

腺苷蛋氨酸联合门冬氨酸钾镁与苦黄注射液治疗慢性乙型肝炎肝内胆汁淤积综合征效果比较

我院在基础护肝治疗基础上加用腺苷蛋氨酸联合门冬氨酸钾镁治疗慢性乙型肝炎肝内胆汁淤积综合征，并与基础护肝加苦黄注射液治疗作比较，取得满意效果。现报道如下：     

中文期刊发表的中医药治疗冠心病的系统评价／Meta分析的方法学质量评价

目的：评价中医药治疗冠心病的系统评价／Meta分析的方法学质量,促进国内系统评价的发展。方法：计算机检索中国生物医学文献数据库（CBM）、中国期刊全文数据库（CNKI）、维普数据库（VIP）及万方数据库;手工检索《中国循证医学杂志》、《中华心血管病杂志》、《国际心血管病杂志》及《中国中西医结合杂志》,引文亦进行检索,检索时间均为2000年1月-2012年9月;采用AMSTAR量表对纳入文献进行方法学质量评价。结果：共纳入68篇系统评价／Meta分析,AMSTAR量表评分结果显示,无高质量文献,中等质量者17篇（25．0％）,低质量者51篇（75．0％）,尚不能认为系统评价的方法学质量与发表年代有关;在提供研究计划书、文献查全率、原始文献质量鉴定、系统评价缺陷自评、原始研究的合成方法、发表偏倚判定及利益冲突说明等方面还需进一步提高。结论：中文期刊发表的中医药治疗冠心病的系统评价／Meta分析的方法学质量普遍较低,应加强系统评价／Meta分析人员的方法学培训。     

肝苏颗粒治疗慢性乙型肝炎的系统评价

目的 系统评价肝苏颗粒治疗慢性乙型肝炎的有效性.方法 计算机检索Cochrane图书馆、PubMed、CBM、VIP、CNKI、万方数据库,检索时间范围均为建库至2011年1月.手工检索其他消化病相关杂志.对纳入文献的随机对照试验进行质量评价,并进行Meta分析.结果 共纳入研究8篇,其中1篇为半随机设计.Meta分析显示肝苏颗粒疗效优于对照组,差异有统计学意义(P＜0.05).结论 肝苏颗粒治疗慢性乙型肝炎疗效确切,但纳入研究较少、研究质量普遍不高,上述结果还有待高质量、大样本的随机双盲对照试验加以验证.     

头痛宁与西药治疗偏头痛有效性与安全性的Meta分析

目的系统评价头痛宁治疗偏头痛的临床疗效。方法通过检索Pub Med、VIP中文期刊数据库、Wan Fang全文数据库和CNKI全文数据库,并采用Rev Man 5.2进行统计分析。结果最终纳入27篇文献（共3 009例患者）,Meta分析结果显示：总体有效率为[RR=1.21,95%CI（1.17,1.26）,P〈0.00001],差异有统计学意义。漏斗图不对称纳入随机对照试验（RCTs）存在潜在的发表偏倚,安全性评价显示头痛宁不良反应较少。结论头痛宁治疗偏头痛明显优于西药。但由于本研究纳入的文献质量较低,尚需高质量、低偏倚风险的研究进一步证实,为头痛宁治疗偏头痛提供科学依据。     

恩替卡韦和拉米夫定治疗慢性乙型肝炎的Meta分析

目的系统评价恩替卡韦和拉米夫定治疗慢性乙型肝炎的疗效与安全性。方法检索Cochrane Library,PubMed,Ovid,Elsevier,中国期刊全文数据库（CNKI）,万方数字化期刊全文库,中文科技期刊全文数据库（维普）公开发表的相关随机对照试验（RCT）,并手工检索纳入研究的参考文献。对纳入的研究进行质量评价和数据提取,采用RevMan5．2软件进行Meta分析。当,〈50％时认为纳入研究结果同质性较好．采用固定效应模型计算合并统计量;当I^2≥50％时,则选择随机效应模型计算合并统计量。结果最终纳入27篇文献。Meta分析结果显示,对于HBVDNA转阴率、ALT复常率,HBeAg转阴率和HBeAg血清学转化率,恩替卡韦组均显著高于拉米夫定组;在不良反应发生率方面,2组无统计学差异。结论当前的研究显示,恩替卡韦对慢性乙型肝炎的疗效优于拉米夫定,2药的不良反应发生率相似。相关结果需要样本量更大,设计更严谨的大型多中心的临床随机对照试验。     

茵栀黄、门冬氨酸钾镁及腺苷蛋氨酸治疗乙型病毒性肝炎黄疸效果比较

慢性乙型病毒性肝炎部分患者血清胆红素升高，常与肝细胞坏死程度相关，退黄治疗是病毒性肝炎治疗极其重要的组成部分，因此胆红素常作为疗效指标之一。本文旨在观察临床中常用的茵栀黄、门冬氨酸钾镁及腺苷蛋氨酸三者的治疗效果。     

Efficacy of gut lavage,hemodialysis, and hemoperfusion in the therapy of paraquat or diquat intoxication

Clinical and in vitro investigations were carried out to test the efficacy of gut lavage, hemodialysis, and hemoperfusion in the treatment of poisoning with paraquat or diquat. In a patient suffering from diquat intoxication 130 times more diquat was removed by gut lavage 30 h after ingestion than was removed by complete aspiration of the gastric contents.Determination of in vitro clearances for paraquat and diquat by hemodialysis showed that, at serum concentrations of 1–2 ppm, such as are frequently encountered in poisoning in man, toxicologically relevant quantities of herbicide cannot be removed from the body. At a concentration of 20 ppm, on the other hand, hemodialysis proved to be effective, the clearance being 70 ml/min at a blood flow rate of 100 ml/min. The efficacy of hemoperfusion with coated activated charcoal was on the whole better. Especially at concentrations around 1–2 ppm, the clearance values for hemoperfusion were some 5–7 times higher than those for hemodialysis.In a patient suffering from paraquat poisoning, both hemodialysis as well as hemoperfusion were carried out. The in vitro results could be confirmed: At serum concentrations of paraquat less than 1 ppm no clearance could be obtained by hemodialysis while by hemoperfusion with activated charcoal quite high clearance values were measured and the serum level dropped down to zero.

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Zusammenfassung Klinische Untersuchungen und Laboratoriumsversuche wurden durchgeführt, um die Wirksamkeit von Darmspülung, Hämodialyse und Hämoperfusion bei Paraquat- und Deiquat-Vergiftungen zu prüfen.Bei einem Patienten wurde 30 Std nach Deiquat-Aufnahme durch Darmspülung 130mal mehr Deiquat entfernt als durch vollständige Aspiration des Mageninhaltes. In vitro-Versuche ergaben, daß bei Blutserumkonzentrationen von 1–2 ppm, die bei Vergiftungen oft gemessen werden, durch Hämodialyse keine toxikologisch relevanten Paraquat- oder Deiquat-Mengen entfernt werden können. Dagegen erwies sich die Hämodialyse bei 20 ppm und einer Blutumlaufgeschwindigkeit von 100 ml/min mit einer Clearance von 70 ml/min als wirksam. Die Hämoperfusion mit beschicheter Aktivkohle war in diesen Versuchen aber eindeutig überlegen, denn insbesondere bei Konzentrationen um 1–2 ppm waren die Clearance-Werte 5–7mal höher als bei der Hämodialyse.Die in vitro-Ergebnisse wurden bei einem Patienten mit einer Paraquat-Vergiftung bestätigt: Bei Konzentrationen unter 1 ppm war die Hämodialyse wirkungslos, während durch Hämoperfusion relativ hohe Clearance-Werte erreicht wurden, so daß der Serumspiegel rasch unter die Nachweisgrenze abfiel.

     

In vitro studies on sterically stabilized liposomes (SL) as enzyme carriers in organophosphorus (OP) antagonism

This study describes a new approach for organophosphorous (OP) antidotal treatment by encapsulating an OP hydrolyzing enzyme, OPA anhydrolase (OPAA), within sterically stabilized liposomes. The recombinant OPAA enzyme was derived from Alteromonas strain JD6. It has broad substrate specificity to a wide range of OP compounds: DFP and the nerve agents, soman and sarin. Liposomes encapsulating OPAA (SL)* were made by mechanical dispersion method. Hydrolysis of DFP by (SL)* was measured by following an increase of fluoride ion concentration using a fluoride ion selective electrode. OPAA entrapped in the carrier liposomes rapidly hydrolyze DFP, with the rate of DFP hydrolysis directly proportional to the amount of (SL)* added to the solution. Liposomal carriers containing no enzyme did not hydrolyze DFP. The reaction was linear and the rate of hydrolysis was first order in the substrate. This enzyme carrier system serves as a biodegradable protective environment for the recombinant OP-metabolizing enzyme, OPAA, resulting in prolongation of enzymatic concentration in the body. These studies suggest that the protection of OP intoxication can be strikingly enhanced by adding OPAA encapsulated within (SL)* to pralidoxime and atropine.     

Aquatic Insects and Trace Metals: Bioavailability,Bioaccumulation, and Toxicity

Abstract

The uptake of metals from food and water sources by insects is thought to be additive. For a given metal, the proportions taken up from water and food will depend both on the bioavailable concentration of the metal associated with each source and the mechanism and rate by which the metal enters the insect. Attempts to correlate insect trace metal concentrations with the trophic level of insects should be made with a knowledge of the feeding relationships of the individual taxa concerned. Pathways for the uptake of essential metals, such as copper and zinc, exist at the cellular level, and other nonessential metals, such as cadmium, also appear to enter via these routes. Within cells, trace metals can be bound to proteins or stored in granules. The internal distribution of metals among body tissues is very heterogeneous, and distribution patterns tend to be both metal and taxon specific. Trace metals associated with insects can be both bound on the surface of their chitinous exoskeleton and incorporated into body tissues. The quantities of trace meals accumulated by an individual reflect the net balance between the rate of metal influx from both dissolved and particulate sources and the rate of metal efflux from the organism. The toxicity of metals has been demonstrated at all levels of biological organization: cell, tissue, individual, population, and community. Much of the literature pertaining to the toxic effects of metals on aquatic insects is based on laboratory observations and, as such, it is difficult to extrapolate the data to insects in nature. The few experimental studies in nature suggest that trace metal contaminants can affect both the distribution and the abundance of aquatic insects. Insects have a largely unexploited potential as biomonitors of metal contamination in nature. A better understanding of the physico-chemical and biological mechanisms mediating trace metal bioavailability and exchange will facilitate the development of general predictive models relating trace metal concentrations in insects to those in their environment. Such models will facilitate the use of insects as contaminant biomonitors.     

Pharmacological treatment of COVID-19: an opinion paper

The precocity and efficacy of the vaccines developed so far against COVID-19 has been the most significant and saving advance against the pandemic. The development of vaccines has not prevented, during the whole period of the pandemic, the constant search for therapeutic medicines, both among existing drugs with different indications and in the development of new drugs. The Scientific Committee of the COVID-19 of the Illustrious College of Physicians of Madrid wanted to offer an early, simplified and critical approach to these new drugs, to new developments in immunotherapy and to what has been learned from the immune response modulators already known and which have proven effective against the virus, in order to help understand the current situation.     

Alzheimer’s disease – current trends in basic and clinical research. Highlights from the 16th ECNP

Advances in the molecular biological knowledge of neuronal nicotinic acetylcholine receptors (nAChRs) have led to a growing interest by the pharmaceutical industry in the development of novel compounds that selectively modulate nAChR function. The ability of (-)-nicotine, an activator of nAChRs, to enhance attentional aspects of cognition in animals and humans, to exert neuroprotective and anxiolytic-like effects, and presumably to mediate the negative correlation between smoking and Alzheimer's (and Parkinson's) Disease, has focused interest on the potential therapeutic utility of modulators of nAChR function for treatment of some of the deficits associated with these progressive, neurodegenerative conditions. Numerous compounds are known which activate nAChRs and which might serve as lead compounds toward the development of such agents. The pharmacologic diversity of neuronal nAChR subtypes suggests the possibility of developing selective compounds which would have more favourable side-effect profiles than existing agents. This broader class of agents, collectively called cholinergic channel modulators (ChCMs), is anticipated to encompass compounds which would have more favourable side-effect profiles than existing agents, which generally exhibit low selectivity. This selectivity may be achieved by preferentially activating some subtypes of nAChRs (i.e., Cholinergic Channel Activators, ChCAs) or inhibiting the function of other subtypes (Cholinergic Channel Inhibitors, ChCIs). An overview of the biology of nAChRs and the rationale for the use of ChCMs for the treatment of dementia related to neurodegenerative diseases are presented, followed by a discussion of lead compounds and compounds under consideration for clinical evaluation.     

Steroidal sapogenin contents in some domestic plants

In order to find out the values of the steroid resources for the future use. the compositions and contents of steroidal sapogenins from 13 domestic plants have been investigated. As a result,Dioscorea nipponica, D. quinqueloba andSmilax china were found to have large amount of diosgenin. And pennogenin inTrillium kamtschaticum andParis verticillata, yuccagenin inAllium fistulosum, hecogenin inAgave americana and neochlorogenin inSolanum nigum were appeared to be major steroidal sapogenins.